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Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Original Article Methicillin-Resistant S.

Aureus Infections among Patients in the Emergency Department Gregory J. Moran, M.D., Anusha Krishnadasan, Ph.D., Rachel J. Gorwitz, M.D., M.P.H., Gregory E. Fosheim, M.P.H., Linda K. McDougal, M.S., Roberta B. Carey, Ph.D., and David A. Talan, M.D., for the EMERGEncy ID Net Study Group N Engl J Med 2006; 355:666-674 DOI: 10. Cinque Storie Ferraresi Pdf Viewer there. 1056/NEJMoa055356.

Methods We enrolled adult patients with acute, purulent skin and soft-tissue infections presenting to 11 university-affiliated emergency departments during the month of August 2004. Cultures were obtained, and clinical information was collected. Aureus isolates were characterized by antimicrobial-susceptibility testing, pulsed-field gel electrophoresis, and detection of toxin genes. On MRSA isolates, we performed typing of the staphylococcal cassette chromosome mec (SCC mec), the genetic element that carries the mecA gene encoding methicillin resistance. Aureus was isolated from 320 of 422 patients with skin and soft-tissue infections (76 percent). The prevalence of MRSA was 59 percent overall and ranged from 15 to 74 percent. Mahjong Free Download Windows 8. Pulsed-field type USA300 isolates accounted for 97 percent of MRSA isolates; 74 percent of these were a single strain (USA300-0114).

SCC mec type IV and the Panton–Valentine leukocidin toxin gene were detected in 98 percent of MRSA isolates. Other toxin genes were detected rarely. Among the MRSA isolates, 95 percent were susceptible to clindamycin, 6 percent to erythromycin, 60 percent to fluoroquinolones, 100 percent to rifampin and trimethoprim–sulfamethoxazole, and 92 percent to tetracycline. Antibiotic therapy was not concordant with the results of susceptibility testing in 100 of 175 patients with MRSA infection who received antibiotics (57 percent). Among methicillin-susceptible S. Aureus isolates, 31 percent were USA300 and 42 percent contained pvl genes. Methicillin-resistant Staphylococcus aureus (MRSA) emerged in the 1960s as a cause of infection among patients exposed to the bacteria in health care settings.

More recently, MRSA infections have been reported among persons without such exposure (community-associated MRSA). Community-associated outbreaks of MRSA infection have occurred among prisoners, intravenous-drug users, athletes, military trainees, and men who have sex with men. Community-associated MRSA has primarily been described as a cause of skin and soft-tissue infections, but it has also been associated with sepsis and necrotizing pneumonia. As compared with health care–associated MRSA isolates, community-associated MRSA isolates tend to be resistant to fewer antibiotics, to produce different toxins, and to have different types of the gene complex known as staphylococcal cassette chromosome mec (SCC mec); this complex contains the mecA gene that confers methicillin resistance.